Chen Amanda C, Fu Christina X, Grabowski David C
Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts.
Harvard Graduate School of Arts and Sciences, Boston, Massachusetts.
JAMA Netw Open. 2025 Aug 1;8(8):e2525336. doi: 10.1001/jamanetworkopen.2025.25336.
Enrollment in Medicare Advantage (MA) is expected to continue growing. Previous studies have examined differences in the use and quality of home health care between MA and traditional Medicare, but less is known about outcomes among patients receiving care from agencies with greater exposure to MA patients.
To examine the association between home health agency (HHA) experience with caring for MA patients and quality of care delivered.
DESIGN, SETTING, PARTICIPANTS: This cohort study included patients continuously enrolled in MA and who received HHA care in 2019. The data analysis was performed between July 16, 2024, and January 16, 2025.
Medicare beneficiaries who received home health care from agencies with differing levels of MA specialization.
Primary outcomes included hospitalizations during the HHA episode and after HHA discharge (at 30 and 90 days), length of stay, and total number of visits. Secondary outcomes included postdischarge mortality and nursing home admission. The outcomes were measured using instrumental variable analysis. The treatment variable was a continuous measure of the HHA-level share of MA patients. The instrumental variable was the differential distance from the nearest MA-specialized HHA to nearest non-MA-specialized HHA (based on the 75th percentile of the HHA-level share of MA patients from January 1 to December 31, 2019 [ie, ≥36.4%]).
The study included 749 719 MA patients who received HHA care in 2019 (mean [SD] age, 76.2 [10.4] years; 61.6% female; 26.3% with dual eligibility), of whom 65.4% received care from an MA-specialized HHA and 34.6% received care from a non-MA-specialized HHA. A 1-mile increase in differential distance was associated with a lower likelihood of admission to more MA-specialized HHAs (0.3 percentage points; SE, 0.015 percentage points; F statistic, 450.73). In the instrumental variable analysis, receiving care from more specialized HHAs was associated with a shorter length of stay (coefficient [SE], -15.14 [2.84] days) and fewer total HHA visits (coefficient [SE], -9.40 [1.15] visits) alongside more hospitalizations and nursing home admissions after discharge from the HHA.
In this cohort study of MA patients who received HHA care, those receiving care from more MA-specialized HHAs had lower service use during the HHA episode, but no clear differences compared with non-MA-specialized HHAs were observed in care use after discharge. These findings are important given the costs associated with delivering HHA care and the expected growth in MA enrollment.
预计参加医疗保险优势计划（MA）的人数将持续增长。以往的研究考察了MA与传统医疗保险在家庭医疗保健使用和质量方面的差异，但对于接受MA患者比例更高的机构所护理患者的结局了解较少。
研究家庭健康机构（HHA）护理MA患者的经验与所提供护理质量之间的关联。
设计、设置、参与者：这项队列研究纳入了2019年持续参加MA并接受HHA护理的患者。数据分析于2024年7月16日至2025年1月16日进行。
从MA专业化程度不同的机构接受家庭医疗保健的医疗保险受益人。
主要结局包括HHA护理期间及HHA出院后（30天和90天）的住院情况、住院时长和总访视次数。次要结局包括出院后死亡率和疗养院入住情况。结局采用工具变量分析进行衡量。治疗变量是HHA层面MA患者比例的连续测量值。工具变量是从最近的MA专业化HHA到最近的非MA专业化HHA的差异距离（基于2019年1月1日至12月31日HHA层面MA患者比例的第75百分位数[即≥36.4%]）。
该研究纳入了2019年接受HHA护理的749719名MA患者（平均[标准差]年龄为76.2[10.4]岁；61.6%为女性；26.3%具有双重资格），其中65.4%接受了MA专业化HHA的护理，34.6%接受了非MA专业化HHA的护理。差异距离每增加1英里，进入MA专业化程度更高的HHA的可能性就降低（0.3个百分点；标准误，0.015个百分点；F统计量，450.73）。在工具变量分析中，接受更专业化HHA的护理与住院时长缩短（系数[标准误]，-15.14[2.84]天）和HHA总访视次数减少（系数[标准误]，-9.40[1.15]次）相关，同时HHA出院后住院和疗养院入住情况增多。
在这项针对接受HHA护理的MA患者的队列研究中，接受MA专业化程度更高的HHA护理的患者在HHA护理期间的服务使用较少，但与非MA专业化HHA相比，出院后的护理使用情况没有明显差异。鉴于提供HHA护理的成本以及MA参保人数的预期增长，这些发现具有重要意义。
